Chronic kidney disease (CKD) affects >10% of the adult population. Each year, approximately 120,000 Americans develop end-stage kidney disease and initiate dialysis, which is costly and associated with functional impairments, worse health-related quality of life, and high early-mortality rates, exceeding 20% in the first year. Recent declarations by the World Kidney Day and the U.S. Government Executive Order seek to implement strategies that reduce the burden of kidney failure by slowing CKD progression and controlling uremia without dialysis. Pragmatic dietary interventions may have a role in improving CKD outcomes and preventing or delaying dialysis initiation. Evidence suggests that a patient-centered plant-dominant low-protein diet (PLADO) of 0.6–0.8 g/kg/day composed of >50% plant-based sources, administered by dietitians trained in non-dialysis CKD care, is promising and consistent with the precision nutrition. The scientific premise of the PLADO stems from the observations that high protein diets with high meat intake not only result in higher cardiovascular disease risk but also higher CKD incidence and faster CKD progression due to increased intraglomerular pressure and glomerular hyperfiltration. Meat intake increases production of nitrogenous end-products, worsens uremia, and may increase the risk of constipation with resulting hyperkalemia from the typical low fiber intake. A plant-dominant, fiber-rich, low-protein diet may lead to favorable alterations in the gut microbiome, which can modulate uremic toxin generation and slow CKD progression, along with reducing cardiovascular risk. PLADO is a heart-healthy, safe, flexible, and feasible diet that could be the centerpiece of a conservative and preservative CKD-management strategy that challenges the prevailing dialysis-centered paradigm.

Chronic kidney disease (CKD) affects >10% of the adult population. Each year approximately 120,000 Americans develop end-stage kideny disease and initiate dialysis, which is costly and associated with functional impairments, worse health-related quality of life, and high early-mortality rates exceeding 20% in the first year. Recent declarations by the World Kidney Day and the U.S. Government Executive Order seek to implement strategies that reduce the burden of kidney failure by slowing CKD progression and controlling uremia without dialysis. Pragmatic dietary interventions may have a role in improving CKD outcomes and preventing or delaying dialysis initiation. Evidence suggests that a patient-centered plant-dominant low-protein diet (PLADO) of 0.6-0.8 g/kg/day comprised of >50% plant-based sources, administered by dietitians trained in non-dialysis CKD care, can be promising. The scientific premise of the PLADO is based on the observations that high protein diets with high meat intake are not only associated with higher cardiovascular disease risk but also higher CKD incidence and faster CKD progression due to increased intraglomerular pressure and glomerular hyperfiltration. Meat intake increases production of nitrogenous end-products, worsens uremia, and may increase the risk of hyperkalemia, given constipation from the typical low fiber intake. Plant-dominant, fiber-rich, low-protein diet may lead to favorable alterations in the gut microbiome, which can modulate uremic toxin generation and slow CKD progression, along with reducing cardiovascular risk in CKD patients. PLADO is a heart-healthy, safe, flexible, and feasible diet that could be the centerpiece of a conservative and preservative CKD-management strategy that challenges the prevailing dialysis-centered paradigm.

Culinary medicine is an emerging, evidence-based discipline that integrates medical and nutritional care with practical culinary strategies to mitigate the risk and progression of CKD. Culinary medicine, which falls under the broader movement of Food is Medicine, supports culturally relevant, person-centered health care goals. It addresses strategies to overcome the health risks of the standard American diet, high in animal protein, salt, sugar, and ultraprocessed foods. Recent guidelines, including the Kidney Disease Outcomes Quality Initiative Clinical Practice Guidelines for Nutrition in CKD 2020 and Kidney Disease Improving Global Outcomes 2024 Clinical Practice Guideline for Evaluation and Management of CKD, recommend adoption of plant-rich eating patterns, on the basis of the large body of evidence highlighting benefits such as reduced net acid production, lower body weight, and improved BP. Transition to a kidney-friendly eating pattern is often hindered by barriers, such as time, budget, and culinary skills. This innovative field uses food as a preventive and therapeutic tool to overcome barriers to the actionable food choices needed for better health. The aim of this article was to ( 1 ) underscore the role of culinary medicine in lifestyle intervention to improve CKD outcomes and ( 2 ) explore practical implementation of culinary medicine in CKD management to optimize patient well-being. While direct, large-scale clinical trials specifically on culinary medicine in CKD are still emerging, the synergy of nutritional evidence and experiential strategies points to its promise as a preventive and therapeutic tool for improving CKD outcomes. Increasing awareness of the existence and effectiveness of culinary medicine within the nephrology community can foster meaningful discussions about impactful lifestyle changes that influence patient outcomes.